Subcutaneous Achilles tendon lengthening in the treatment of spastic equinus contracture

Background. Despite the significant progress in medicine in recent years, the number of children with cerebral palsy world-wide is growing systematically, often causing treatment problems. The goal of the present study was to evaluate lengthening of the Achilles tendon in the subcutaneous treatment of equines contractures. Material and methods. We analyzed 104 patients treated in Adult and Pediatric Orthopedics Clinic at the Lodz medical University from 1984 to 2001, in the course of multi-level release in the soft tissues. 53 patients reported for follow-up examinations, and 42 of these were selected for lengthening of the Achilles tendon using the White or Hoke methods. In 20 cases the operation was bilateral, giving a total of 62 feet. The average age at surgery was 6.19 years (range 2-13 years). All these patients presented with spastic palsy. Results. All patients or caregivers, and if possible the child as well, reported significant improvement of the overall clinical status and better gait efficiency. There were no complications in the healing of the surgical wounds. In a clear majority of cases no scars were visible on the skin. The appearance of the Achilles tendon did not show signs of surgical intervention and resembled normal structures. No heel deformities occurred. Conclusions. There was no essential difference in long-term outcome, and traditional methods. In view of the simplicity of operation, the cosmetic outcome, and earlier resumption of rehabilitation, subcutaneous lengthening should be considered the method of choice.